Psychological determinants of health-related quality of life in primary care patients with diabetic foot ulcers: a cross-sectional study in Singapore

Background Diabetic foot ulcers (DFUs) significantly impair health-related quality of life (HRQoL). While clinical predictors are well established, the contribution of psychological factors, particularly in primary care, remains underexplored.

Aim To examine the sociodemographic, clinical, and psychological determinants of HRQoL in individuals with DFUs to inform development of psychologically informed interventions.

Design & Setting Cross-sectional study in primary care settings.

Method A total of 186 patients with DFUs completed validated measures, including psychological variables (eg, the Diabetes Distress Scale and Brief Illness Perception Questionnaire) and Wound-QoL, which assesses quality of life in Body, Psyche, and Everyday Life domains. Hierarchical multiple regression analyses evaluated the contribution of psychological variables to HRQoL.

Results Psychological burden dominated, with Psyche HRQoL impaired in 57% of participants (mean = 2.0), outpacing Everyday Life (38%; mean = 1.3) and Body domains (24%; mean = 0.8). In hierarchical models, psychological variables—together with sociodemographic and clinical factors—explained 31.4% of the variance in Body HRQoL, with interpersonal distress and threat perceptions emerging as significant predictors. A similar model accounted for 39.2% of the variance in Psyche HRQoL, with female gender, emotional burden, and threat perceptions as key predictors. Everyday Life HRQoL was significantly associated with HbA1c, independence in daily activities, emotional burden, and threat perceptions, with the full model explaining 40.9% of the variance.

Conclusion Psychological factors significantly contributed to reduced HRQoL in primary care patients with DFUs. Routine screening and targeted, psychologically informed support—particularly for women, those with poor glycaemic control, or limited functional independence—are essential to improve outcomes.